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Opioidinduzierter Pruritus

Mechanismen und therapeutische Ansätze

Opioid-induced pruritus

Mechanisms and treatment regimens

  • Schmerztherapie
  • Published:
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Zusammenfassung

In der Erforschung von Interaktionen zwischen Schmerz und Juckreiz sind in den letzten Jahren erhebliche Fortschritte erzielt worden. Über die bekannte Hemmung von Juckreiz durch schmerzhafte Reize (z. B. kratzen) hinaus wurde durch die Entdeckung von juckreizspezifischen neuronalen Verarbeitungsbahnen eine Grundlage zur Erklärung von opioidinduziertem Juckreiz geschaffen. Während traditionell die mastzelldegranulierende Wirkung von Opioiden als wesentlicher Mechanismus angenommen wurde, ist nunmehr klar, dass Opioide auch auf spinaler Ebene Juckreiz auslösen können: Spinale Juckreizneurone werden tonisch von Hinterhornneuronen des Schmerzsystems gehemmt. Wird diese Hemmung durch Opioide geschwächt, werden die so disinhibierten Juckreizneurone aktiv und vermitteln Juckreiz, ohne dass primäre Afferenzen in der Peripherie erregt werden. Die spinale Auslösung von Juckreiz wird insbesondere bei der Aktivierung von µ-Opioidrezeptoren (μ-OR) beobachtet, während κ-OR überraschenderweise den Juckreiz unterdrücken. Die therapeutischen Implikationen dieser Interaktionen werden im vorliegenden Beitrag ausgeführt.

Abstract

Substantial progress has been achieved in recent years in research on the interaction between pain and pruritus. Over and above the known inhibition of pruritus by painful stimuli (e.g. scratching), a foundation for the explanation of opioid-induced pruritus was laid through the discovery of pruritus-specific neuronal processing channels. Although traditionally the degranulating effect of opioids on mast cells was assumed to be the essential mechanism, it is now clear that opioids can also induce itching at the spinal level. Neurons of the dorsal horn of the pain system inhibit spinal itch neurons. If this inhibition is weakened by opioids, the disinhibited itch neurons become active and mediate itching, without stimulation of the primary afferent peripheral nerves. Spinal triggering of itching is observed in particular by activation of µ-opioid receptors (μ-OR), while κ-OR surprisingly suppress itch. The therapeutic implications of this interaction will be described.

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Danksagung

Diese Arbeit wurde von der Deutschen Forschungsgemeinschaft (KFO 107) unterstützt.

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  1. Institut für Anästhesiologie und Operative Intensivmedizin, Klinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland

    M. Schmelz MD

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Schmelz, M. Opioidinduzierter Pruritus. Anaesthesist 58, 61–65 (2009). https://doi.org/10.1007/s00101-008-1478-8

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